There are two primary thyroid hormones. T4 is the "storage" for of the thyroid hormones. Before it can be used by your body, T4 must be converted to T3, which is the "active" form. The theory behind taking T4 (Synthroid and generics) only is that your body will convert the T4 to T3 as needed.
In reality, once on meds, some people do not convert as quickly as they should and feel much better with a little T3 meds added in. This gives them a direct and immediately source of T3. Cytomel is synthetic T3, and desiccated thyroid (Armour and others) contains both T3 and T4.
If you're not feeling as well as you think you could, you might just need an increase in meds, or you might benefit from adding T3 to your meds. Do you have recent labs? If so, please post FREE T3, FREE T4 and TSH with their reference ranges from your own lab report. We can better advise you after seeing those.
Do you know if you have Hashi's?
My labs are close to a year old. I am due to have them done again.
I have never been tested for Hashimoto's. However, my mother is a thyroid patient (on 2 tablets of 112 Synthroid daily) and just recently found out she has Hashi's. I would assume I have it but I am not sure.
The doctor I see is a pcp. I need to find a good endo in my area.
Yes, even if you are feeling well and on a very stable dose of meds, a year is much too long between labs. As a cost savings, I only see my endo once a year, but I have labs after each six months, and we talk on the phone if anything concerns either of us.
Hashi's is the most prevalent cause of hypo in the part of the world where iodine deficiency isn't an issue. So, if you're hypo, there's a good chance you have it. Add in the genetic component, and you're a pretty sure bet!
I'd advise you to shop smartly for a thyroid doctor. Many endos are really only interested in diabetes and don't keep up on thyroid. I'd make a few calls and talk to a nurse to ask a few key questions before making an appointment. One of our members keeps a list of doctors recommended by other forum members. I'll see if we have anyone near Atlanta. If we do, I'll send you a PM (go to the top of the page to the blue bar, click My MedHelp and check your Inbox). If you're interested in pre-interviewing doctors, I'd be happy to suggest some questions for them.
Also, a red flag...your mother is on 225 mcg Synthroid per day, which is a pretty hefty dose. Does she feel well on that?
I saw your PM. I think Savannah is too far of a drive for me. However, I would like some questions to ask when interviewing doctors. I see some near me, I just havent given them a shot.
My mom has had problems of and on through the years. She had a sonogram done of her thyroid and it seems that her thyroid is totally shot (she has been a thyroid patient for 35 years). She was interested in going on Armour but no doctors would put her on it.
If you're interviewing an endo, the first question I'd ask is how much of their practice is thyroid patients. Many endos specialize in diabetes and couldn't really have any less interest in thyroid. Larger metro areas tend to have endos who specialize where smaller markets tend to have more "generalists".
You can ask which tests they regularly order for hypo patients. If they say TSH only...run, don't walk. You want to hear FT3, FT4 and TSH. Practically speaking, if they say TSH and FT4, I'd go on to ask if they order FT3 on patient request.
Another good question is which meds they are open to prescribing. Once again, anyone who only prescribes T4 is someone to run from. Ideally, they should use everything available...synthetic T3 and T4 and desiccated. Once again, though, practically speaking, doctors tend to fall into the "synthetic" camp or the "desiccated" camp.
You can also ask if they treat by the numbers or clinically for maximum symptoms relief.
Beyond that, if you have any other issues that might interact with your thyroid condition, you can ask if the doctor has expertise in treating the two together, or anything else that is of particular concern to you.
My thyroid is totally shot as well! If you have your mother's recent labs, we can take a look and see what we see. Generally speaking, when people are on a relatively high dose of T4, as she is, and still don't feel totally up to par, it's because T3 is low. However, that's impossible to say definitively without seeing labs.
Thank you so much for the questions! Since I live in Atlanta, I see tons of endos all around town- I just never knew what to ask them!
My mom is out of town right now but I do know that on her last labs (about 3 months ago) her TSH was 15 (really high). I think they were talking about changing her prescription again. I am not sure about FT3 or FT4.
A TSH of 15 would indicate that she's quite hypo. However, if that's all her doctor is testing, it's totally inadequate testing to manage meds by. They didn't leave her with a TSH of 15 without doing further testing and/or adjusting her meds, did they???
They did other tests, I just dont remember the results. They did change her Synthroid prescription some.